NPC1L1

Rafael Holdings and Cyclo Therapeutics on Thursday announced a merger agreement as they look to spur development of their Niemann-Pick disease type C1 (NPC1) treatment candidate, just weeks before the FDA is set to decide on a rival therapy from Zevra Therapeutics – which, if approved, could become the first drug indicated specifically for NPC1 in the US.The merger aims to accelerate the development of Cyclo's proprietary formulation of hydroxypropyl beta cyclodextrin, known as Trappsol Cyclo, currently in Phase III testing in the TransportNPC study."We… believe that the strength of Rafael's balance sheet and its strong management team will solidify our commitment to deliver the results of the TransportNPC trial for our shareholders and patients," remarked N. Scott Fine, chief executive at Cyclo. The pivotal study, which completed enrollment in May, is expected to yield results from its 48-week interim analysis in mid-2025.Zevra is awaiting an FDA decision on its drug arimoclomol by September 21. The drug was slapped with an initial rejection by the FDA back in 2021, but Zevra resubmitted an application for the orally-delivered, heat shock protein amplifier at the end of last year with additional real-world data from early access programmes, along with results from an open-label extension.A majority of members on an FDA advisory panel recently voted that data in Zevra's resubmission package support the effectiveness of arimoclomol as a treatment for patients with NPC.

– New Labels Expand Treatable Population to ~70 Million Patients in U.S. – – First LDL-C Lowering Non-Statin Indicated for Primary Prevention Patients – – Approvals Based on Positive CLEAR Outcomes Data and Reflect a Highly Differentiated Product Profile – – Positive CHMP Opinion Received; European Cardiovascular (CV) Risk Reduction Label Determination Anticipated in Q2 2024 – – Conference Call and Webcast on Monday, March 25 at 8:00 a.m. ET – ANN ARBOR, Mich.--(BUSINESS WIRE)-- Esperion (NASDAQ: ESPR) today announced that the United States Food and Drug Administration (FDA) has approved broad new label expansions for NEXLETOL® (bempedoic acid) Tablets and NEXLIZET® (bempedoic acid and ezetimibe) Tablets based on positive CLEAR Outcomes data that include indications for cardiovascular risk reduction and expanded LDL-C lowering in both primary and secondary prevention patients. In addition, the enhanced labels support the use of NEXLETOL and NEXLIZET either alone or in combination with statins. They also include new indications for primary hyperlipidemia, alone or in combination with a statin, and are the only LDL-C lowering non-statin drugs indicated for primary prevention patients. This press release features multimedia. View the full release here: U.S. FDA approves broad new labels for NEXLETOL® (bempedoic acid) Tablets and NEXLIZET® (bempedoic acid and ezetimibe) Tablets to prevent heart attacks and cardiovascular procedures in both primary and secondary prevention patients, regardless of statin use. (Photo credit: Esperion) “We are pleased to receive approval for our highly anticipated label expansions in the U.S., which will enable more than 70 million patients to now be eligible for NEXLETOL and NEXLIZET,” said Sheldon Koenig, President and CEO, Esperion. “Importantly, these approvals expand the accessibility of our highly effective drugs to primary prevention patients, or to those who are at high risk of having a cardiovascular event, but who have not yet had one. These approvals also eliminate the statin use requirement, allowing patients to take NEXLETOL or NEXLIZET either with or without a statin, which significantly reduces previously existing prescribing limitations. We are confident these approvals position NEXLETOL and NEXLIZET as the non-statins of first choice within the cardiovascular risk reduction treatment paradigm.” “We are thrilled with these significantly expanded labels and look forward to being able to now reach millions more patients with our life-saving drugs. In anticipation of these approvals, we have significantly ramped up our sales force, developed a powerful suite of new promotional materials, created a bold new consumer campaign, enhanced our patient support programs, and continued working with payers to ensure improved patient access.” “NEXLETOL and NEXLIZET are once-daily, accessible, oral medications that reduce LDL-C and cardiovascular risk, but without the side effects most common to statins. NEXLETOL and NEXLIZET are also the first oral non-statin LDL-C lowering drugs to be approved by the FDA to reduce the risk of CV events in both primary and secondary prevention patients. We believe this significantly differentiated pro a game changer for patients and healthcare providers alike and that we expect sales to meaningfully inflect as a result. I want to thank the entire Esperion team for its unwavering commitment to patients and to getting us to this stage. I have the utmost confidence in our future success.” The Company’s pending label expansions in Europe remain on track, with a positive opinion received from the Committee for Medicinal Products for Human Use (CHMP) on March 21, 2024. The Company anticipates a final determination by the European Medicines Agency in the second quarter of 2024. The U.S. approvals of NEXLIZET and NEXLETOL for cardiovascular risk reduction and LDL-C lowering were based on data generated from the CLEAR Outcomes trial, which was published in the New England Journal of Medicine in March 2023, assessing the effect of NEXLETOL on cardiovascular outcomes in nearly 14,000 patients with, or at high risk, of cardiovascular disease. Patients were followed for a median duration of 3.4 years and bempedoic acid (contained in NEXLETOL and NEXLIZET) was generally safe and well tolerated. In the study, LDL-C was reduced by 20%, hsCRP was reduced by 22%, and glucose was not elevated by bempedoic acid compared to placebo. Patients who received bempedoic acid in the trial experienced a relative risk reduction of: 15% for MACE-3 (death from a cardiovascular cause, nonfatal stroke, or nonfatal myocardial infarction) 27% for nonfatal myocardial infarction 19% for coronary revascularization 39% for MACE-3 in primary prevention patients Conference Call and Webcast Information Esperion will host a conference call and webcast on Monday, March 25 at 8:00 a.m. ET to discuss these FDA approvals and its new and expanded indications for NEXLETOL and NEXLIZET. Please click here to participate in the conference call. The live webcast can also be accessed on the Investors and Media section of the Esperion website. Access to the webcast replay will be available approximately two hours after completion of the call and will be archived on the Company’s website for approximately 90 days. INDICATION NEXLIZET and NEXLETOL are indicated: The bempedoic acid component of NEXLIZET and NEXLETOL is indicated to reduce the risk of myocardial infarction and coronary revascularization in adults who are unable to take recommended statin therapy (including those not taking a statin) with: established cardiovascular disease (CVD), or at high risk for a CVD event but without established CVD. As an adjunct to diet: NEXLIZET, alone or in combination with other LDL-C lowering therapies, to reduce LDL-C in adults with primary hyperlipidemia, including HeFH. NEXLETOL, in combination with other LDL-C lowering therapies, or alone when concomitant LDL-C lowering therapy is not possible, to reduce LDL-C in adults with primary hyperlipidemia, including HeFH. IMPORTANT SAFETY INFORMATION NEXLIZET and NEXLETOL are contraindicated in patients with a prior hypersensitivity to bempedoic acid or ezetimibe or any of the excipients. Serious hypersensitivity reactions including anaphylaxis, angioedema, rash, and urticaria have been reported. Hyperuricemia: Bempedoic acid, a component of NEXLIZET and NEXLETOL, may increase blood uric acid levels, which may lead to gout. Hyperuricemia may occur early in treatment and persist throughout treatment, returning to baseline following discontinuation of treatment. Assess uric acid levels periodically as clinically indicated. Monitor for signs and symptoms of hyperuricemia, and initiate treatment with urate-lowering drugs as appropriate. Tendon Rupture: Bempedoic acid, a component of NEXLIZET and NEXLETOL, is associated with an increased risk of tendon rupture or injury. Tendon rupture may occur more frequently in patients over 60 years of age, in those taking corticosteroid or fluoroquinolone drugs, in patients with renal failure, and in patients with previous tendon disorders. Discontinue NEXLIZET or NEXLETOL at the first sign of tendon rupture. Consider alternative therapy in patients who have a history of tendon disorders or tendon rupture. The most common adverse reactions in the primary hyperlipidemia trials of bempedoic acid, a component of NEXLIZET and NEXLETOL, in ≥2% of patients and greater than placebo were upper respiratory tract infection, muscle spasms, hyperuricemia, back pain, abdominal pain or discomfort, bronchitis, pain in extremity, anemia, and elevated liver enzymes. Adverse reactions reported in ≥2% of patients treated with ezetimibe (a component of NEXLIZET) and at an incidence greater than placebo in clinical trials were upper respiratory tract infection, diarrhea, arthralgia, sinusitis, pain in extremity, fatigue, and influenza. In the primary hyperlipidemia trials of NEXLIZET, the most commonly reported adverse reactions (incidence ≥3% and greater than placebo) observed with NEXLIZET, but not observed in clinical trials of bempedoic acid or ezetimibe, were urinary tract infection, nasopharyngitis, and constipation. The most common adverse reactions in the cardiovascular outcomes trial for bempedoic acid, a component of NEXLIZET and NEXLETOL, at an incidence of ≥2% and 0.5% greater than placebo were hyperuricemia, renal impairment, anemia, elevated liver enzymes, muscle spasms, gout, and cholelithiasis. Discontinue NEXLIZET or NEXLETOL when pregnancy is recognized unless the benefits of therapy outweigh the potential risks to the fetus. Because of the potential for serious adverse reactions in a breast-fed infant, breastfeeding is not recommended during treatment with NEXLIZET or NEXLETOL. Report pregnancies to Esperion Therapeutics, Inc. Adverse Event reporting line at 1-833-377-7633. Please see full Prescribing Information for NEXLIZET and NEXLETOL. Esperion Therapeutics At Esperion, we discover, develop, and commercialize innovative medicines to help improve outcomes for patients with or at risk for cardiovascular and cardiometabolic diseases. The status quo is not meeting the health needs of millions of people with high cholesterol – that is why our team of passionate industry leaders is breaking through the barriers that prevent patients from reaching their goals. Providers are moving toward reducing LDL-cholesterol levels as low as possible, as soon as possible; we provide the next steps to help get patients there. Because when it comes to high cholesterol, getting to goal is not optional. It is our life’s work. For more information, visit esperion.com and esperionscience.com and follow us on X at twitter.com/EsperionInc. CLEAR Cardiovascular Outcomes Trial CLEAR Outcomes is part of the CLEAR clinical research program for NEXLETOL® (bempedoic acid) Tablet and NEXLIZET® (bempedoic acid and ezetimibe) Tablet. The CLEAR Program seeks to generate important clinical evidence on the safety and efficacy of bempedoic acid, a first in a class ATP citrate lyase inhibitor contained in NEXLETOL and NEXLIZET and its potential role in addressing additional critical unmet medical needs. More than 60,000 people will have participated in the program by the time of its completion. The CLEAR Program includes 5 label-enabling Phase III studies as well as other key Phase IV studies with the potential to reach more than 70 million people with or at risk for CVD based on elevated LDL-C. Forward-Looking Statements This press release contains forward-looking statements that are made pursuant to the safe harbor provisions of the federal securities laws, including statements regarding marketing strategy and commercialization plans, current and planned operational expenses, future operations, commercial products, clinical development, including the timing, designs and plans for the CLEAR Outcomes study and its results, plans for potential future product candidates, financial condition and outlook, including expected cash runway, and other statements containing the words “anticipate,” “believe,” “estimate,” “expect,” “intend,” “may,” “plan,” “predict,” “project,” “suggest,” “target,” “potential,” “will,” “would,” “could,” “should,” “continue,” and similar expressions. Any express or implied statements contained in this press release that are not statements of historical fact may be deemed to be forward-looking statements. Forward-looking statements involve risks and uncertainties that could cause Esperion’s actual results to differ significantly from those projected, including, without limitation, the net sales, profitability, and growth of Esperion’s commercial products, clinical activities and results, supply chain, commercial development and launch plans, the outcomes and anticipated benefits of legal proceedings and settlements, and the risks detailed in Esperion’s filings with the Securities and Exchange Commission. Any forward-looking statements contained in this press release speak only as of the date hereof, and Esperion disclaims any obligation or undertaking to update or revise any forward-looking statements contained in this press release, other than to the extent required by law.

UCLA researchers have described a previously unknown step in the complex process by which dietary cholesterol is processed in the intestines before being released into the bloodstream -- potentially revealing a new pathway to target in cholesterol treatment. UCLA researchers have described a previously unknown step in the complex process by which dietary cholesterol is processed in the intestines before being released into the bloodstream -- potentially revealing a new pathway to target in cholesterol treatment. Although an existing drug and statins impact part of the process, an experimental drug being studied in UCLA research labs appears to specifically target the newfound pathway, possibly adding a new approach to the cholesterol management toolbox. "Our results show that certain proteins in the Aster family play a critical role in moving cholesterol through the absorption and uptake process," said Dr. Peter Tontonoz, a UCLA professor and researcher in Pathology and Laboratory Medicine and Biological Chemistry, senior author of an article in Science. "The Aster pathway appears to be a potentially attractive target for limiting intestinal cholesterol absorption and reducing levels of plasma cholesterol." Cholesterol from food is absorbed by cells that line the inner surface of the intestines -- enterocytes -- where it is processed into droplets that eventually reach the bloodstream. But this journey involves a multistep process. Free cholesterol is drawn into the cell's plasma membrane -- the external boundary of the cell -- by a protein called NPC1L1. It then must move to another membranous network in the cell called the endoplasmic reticulum. This is where an enzyme called ACAT2 prepares the cholesterol for packaging and transport, in a process called esterification. Scientists have not known how cholesterol finds its way into the endoplasmic reticulum to be acted upon by ACAT2. In this study, the researchers investigated the Aster protein family, which is known to bind cholesterol and help it move from one membrane to another. "How cholesterol that enters the cell through NPC1L1 reaches the endoplasmic reticulum for esterification and regulation of cholesterol synthesis has been a longstanding mystery," Tontonoz said. "We solve that mystery by showing that two members of the Aster protein family -- Aster-B and -C -- provide the link between NPC1L1 and ACAT2. By attaching to the plasma membrane, these proteins facilitate cholesterol transport to the endoplasmic reticulum." It was previously understood that NPC1L1 was a key player, but this study breaks the process into distinct steps. When NPC1L1 pulls cholesterol from the intestine into the enterocyte, it triggers the recruitment of the Aster proteins. "We show that NPC1L1 and Asters play sequential, nonredundant roles in the delivery of dietary cholesterol from the intestinal lumen to the enterocyte ER (endoplasmic reticulum)," the authors write. Additionally, the researchers found that the Aster proteins may provide a new treatment target for the control of cholesterol levels. When the actions of Aster-B and -C are blocked, cellular cholesterol stores are reduced, and the processing of cholesterol is impaired. An existing drug, ezetimibe, targets NPC1L1, inhibits the activity of ACAT2, and reduces cholesterol absorption. It sometimes is used in combination with statins to reduce blood cholesterol. But ezetimibe doesn't bind sufficiently to Asters to prevent all cholesterol transport. The research team, however, has identified an experimental drug -- a small molecule called AI-3d -- that potently inhibits Aster-A, -B, and -C. In a series of studies in both mice and human cells, the researchers found that the drug inhibits cholesterol absorption by directly targeting the effects of the Asters.